Christian and Medical Research
By Sam Leinster and Helen Barratt
What are the limits on research?
I think this is one of the major challenges we face today. Modern society is characterized by a growing expectation that all illness will eventually be conquered if only enough resources are put into medical research. The corollary of this belief is a deep suspicion of any suggestion that there may be ethical limits to research, especially if these derive from faith. Indeed, there seems to be a perceived conflict between the Christian duty of compassion and the suggestion that some forms of research should be banned on moral grounds.
The clearest current example of this is, as you say, embryo stem cell research.4 All discussions about its ethical standing are brushed aside with the promise that it holds the key to curing all manner of chronic diseases. Quite apart from the fact that little evidence has yet been produced that it will have the promised outcomes, the argument that the end justifies the means is flawed.5
In the real world, however, research will inevitably be limited by resources. Whether the research is funded by public or private sources, there are always conflicting claims on finances. Research will also be limited by the risks involved. It is clearly irresponsible to carry out a research programme unless the potential benefits outweigh the potential risks.6 In medical research in particular, there is a further limitation and that is the rights of the subjects involved. Legally, these are enshrined in the Human Rights Act7 and ethically they arise from notions of human worth.
What are the limits with human subjects?
The general Medical Council has issued clear guidelines on involving human subject in research.8 In clinical trials, for example, patients who are the subjects of the research may benefit directly, but their participant results in benefits to future potential patients as the experiment cannot be interpreted accurately without their involvement. It a tribute to the altruism of the majority of people that so many agree to inclusion in placebo controlled trials knowing they may not actually receive the new treatment.9
Research on children raises further ethical question, as the children may not understand the implications of the proposed study and cannot give informed consent. Third person consent for treatment, from a parent or guardian, is easy to justify when the child may end up in the control group and not receive direct benefit. This can give rise to problem – many potentially useful drugs are not licensed for use in children because the relevant studies have not been carried out.
For the Christian, respect for the patient and the worth of the individual are based on the concept that humans are made in the image of God.10 While emphasis has in the past been placed on the ability to think, to choose and to create as the main evidence of God’s image, the ability to relate to others may be more significant. God is a triune being, and relationship is intrinsic to his nature. Every individual who has ever lived has been loved by God and is, therefore, of infinite worth.
This apparently innocuous statement raises a number of difficult issues, and we must recognize these are questions on which Christians disagree. For example, what is the status of a patient in a persistent vegetative state? Or when does an embryo become a human being? When disagreement occurs, we must act in humility and love, but our answer to these questions will influence our views on where the limits to research should be drawn.11
What about research on animals?
There is a long tradition of using animals in medical research, and many of our current advances would perhaps not have been achieved without the use of animal models. The argument has been that we are justified in using animals in experiments to improve the lot of humans because humans have more intrinsic worth than animals.
The philosopher Peter Singer contends that in taking this view we are guilty of specieism. In his view, worth derives from factors such as self-consciousness and rationality.12 On this basis a higher mammal has more intrinsic value than a patient in a persistent vegetative state, for example, so animals should be afforded the same rights as competent humans.13 Since animals are not capable of giving informed consent, it is asserted they cannot therefore be used legitimately in research. However, there are still many valid questions that cannot yet be addressed without the use of animal models. Again, this is a disputed area where a spirit of open discussion is necessary.14
A minefield for Christians?
Research is no different from any other professional activity in this regard. Even clinical service can be carried out with an eye to our own advancement rather than the patient’s interests. However, I agree that the challenges in research are greater. The prevailing ethos in academia has shifted from research being a means of advancing knowledge, to research being a means of advancing one’s own career or institution. As a result, individuals come under pressure to perform effectively, which means getting grants and publishing papers. This pressure is likely to intensify as the available funding falls and competition becomes greater.
As Christians we must remember that our ultimate responsibility is to God15 and our aim in doing research, as in everything else, is to glorify God.16 For example, be carrying out basic research we are expanding our understanding of the wonder of creation and therefore enlarging our understanding of the wisdom and power of God, which should lead us to a deeper sense of worship.
If we are to keep that focus on God we must maintain a proper balance in our lives. The more absorbing our research becomes (or the more pressure our colleagues put on us to perform), the more important it becomes that we give time to our spiritual growth, including spending time in worship, prayer and study with other Christians.17 Apart from the spiritual benefit, it is a simple fact of psychology that taking regular breaks from a task is more productive than constant application.
I have to admit that the question of humility is one I continue to find difficult. Part of the problem is a misunderstanding of what humility is. It is easy to get it confused with false modesty which underestimates one’s gifts and abilities. Paul instructs us to ‘think carefully about our gifts’.18 Humility comes in recognizing that our gifts do not make us better or more important than anyone else, but they do define the task that God has called us to. Research is as much a calling as clinical care or overseas work.
How much should we spend on research?
Direct patients care is not necessarily the best, or most effective, use of money and we have a responsibility to the wider community as well as to the patients we are caring for immediately. If the money that went into our research on c-erbB2 (now better known as her2) had gone into direct car, its effects would have been transient. Instead, it contributed to the ultimate development of the breast cancer treatment Herceptin which has been of benefit to a wider population of patients.
Will the outcome of your research potentially improve patient care or public health? Will it increase our knowledge of basic human biology or behavior? If the answer is yes, then spending the money makes good economic sense. I realize this does not answer the question with regard to other areas of academic study, such as Egyptology or astrophysics, but you ask the question in the context of healthcare.
As Christian academics we straddle two worlds which can at times seem opposed to each other. It is widely accepted that religion and science are mutually exclusive, but it is part of our task to show this is not true. All truth is God’s truth and science reveals the wisdom and power of God. It is also part of our task to maintain the highest ethical standards within the research community, striving for the highest standards in research and thinking.
Within the church it is easy for an academic or research to feel a second class citizen, compared for example with those called to work overseas. When one is confronted with the challenges of healthcare needs worldwide, it can seem self-indulgent to spent time investigating a small but fascinating topic apparently relevant only to a highly selected group. There are even times when one looks with envy at colleagues who are doing things that are highly respected by the wider Christian community. It is important, however, to remember that God has called us to this task and that our efforts are directed towards pleasing him, not other people.
Sam Leinster was a professor of surgery and is now Head of the School of Medicine, Health Policy and Practice at the University of East Anglia. He has been actively involved in research in different fields for over 30 years
Helen Barratt is a specialist registrar in public health in London and is about to embark on a PhD in health services research
4. See Jones P. Therapeutic Cloning and Stem Cells. CMF File 12 (2000)
5. Romans 3:7-8
6. World Medical Association. Declaration of Helsinki 2008, paragraph 20 www.wma.net/en/30publications/10policies/b3/index.html
7. Human Rights Act 1998 www.opsi.gov.uk/acts/acts1998/ukpga_19980042_en_1
8. GMC Consent to Research, London 2010 www.gmc-uk.org/guidance/ethical_guidance /5993.asp
9. See Vere D. Human Experiments. CMF File 15 (2001)
10. Genesis 1:26-28
11. Romans 14 especially verses 19-21
12. Misselbrook D. Speciesism. CMF File 26 (2004)
13. Singer P. Practical Ethicts 2nd edition. Cambridge University Press 1980
14. See Animal Experimentation. CMF File 2 (1998)
15. Ephesians 6:7
16. 1 Corinthians 10:31
17. Hebrews 10:25
18. Romans 12:3 (The Message)
Christian Medical Fellowship (CMF) Files No. 42, 2010